J Chin Med 20(3,4): 137-144, 2009 137 1 1 1 2 1 1 2 98 01 15 98 04 28 2007/05/24 2007/05/24craniotomy with removal of hematoma 39ºC 38~39ºC 2007/6/21 37ºC 1-4 5,6 7 1069 32-33 o C22% 8 72 9 70% 39 o C 500 135 04-7238595 4228 126478@cch.org.tw
138 1 o C 6%~7% 10 18 craniotomy with removal of hematoma 39 o C 5/28 6/6 Rocephine for Pneumonia 6/8 6/13 Maxipineurine culture : Enterococcussputum culture : Klebsiella pneumonia 6/13 6/15 Mepem + Targocid X 38~39 o C 2007/05/24 Lab Data: 2007/05/24 ph: 7.476 P CO2 : 38.8 mmhg P O2 : 47.9 mmhg intracranial hemorrhage with intraventricular hemorrhage SO 2 %: 83.8 % Hct: 40 % Hb: 13.4 g/dl GCS: E 1 M 3 V 1 Vital sign 2007/6/21 BP:106/64 mmhg HR:144 /min pupil size : R/L 6.0-/2.0-2007/05/24 BT:38.8 o C I/O :4768/3230 c.c. RR:38 /min 2007/06/21 2007/05/24 57x44 mm
139 39 o C 38 o C 1. Head injury with traumatic ICH, left frontal-temporal & IVH craniotomy with removal of hematoma + EVD with ICP monitor insert 2. Respiratory failure 3. R/O Pneumonia 1 2 2 3 1.5 3 2 2 3 3 3 2 2 2 1.5 1.5 300 c.c. 2007/6/22 39 o C 1.5 1.2 3 2 2 2 2007/6/27 38 o C 39 o C 2 3 2 2007/7/5 38 o C 38.8 o C 3 6/29 7/05 2007/7/27 38.3 o C
140 5/24 顱 腦 損 傷 術 後 發 燒, 多 維 持 39 o C 以 上 中 醫 介 入 會 診, 體 溫 38.8 o C 下 巴 紫 色 痤 瘡 大 便 多 日 未 解 今 日 起 體 溫 降 至 38 o C 以 下 下 巴 痤 瘡 盛, 色 暗 紅, 起 刺 狀 手 不 自 主 活 動 E4M4VT 眼 睛 可 睜 開 左 右 移 動 能 夠 依 指 令 作 抬 手 動 作 出 院 後 續 復 健 5/24 6/21 6/22 6/23 由 前 方 去 橘 紅 加 大 黃 至 1.2 錢 地 骨 皮 3 錢 女 貞 子 2 錢 6/25 加 紫 草 2 錢 白 鮮 皮 2 錢 7/5 去 珍 珠 母 7/14 7/27 8/17 加 入 針 刺 治 療 2 3 3 5 2007/8/17 18. 11 39 o C 12
141 外 傷 引 致 氣 滯 血 瘀 離 經 之 血 氣 滯 不 通 釀 為 熱 邪 營 陰 不 足 熱 盛 燔 灼 耗 氣 傷 陰 血 不 濡 筋 脈 弦 脈 澀 熱 盛 血 燔, 痤 瘡 盛, 色 紅, 尺 膚 熱, 脈 數 肝 陰 不 足, 筋 脈 拘 急, 牙 關 緊 閉 熱 盛 傷 津, 大 腸 腑 結 38 o C 40 體 溫 變 化 表 39.5 39 38.5 38 37.5 37 36.5 36 35.5 35 5/26 5/28 5/31 6/3 6/4 6/7 6/11 6/14 6/15 6/18 6/21 6/25 6/28 7/2 7/4 7/7 7/10 7/13 7/16 7/17 7/25 日 期 8:00 am
142 13 14 15 16 17 18 1. Azzimondi G, Bassein L, Nonino F, Fiorani L, Vignatelli L, Re G, D'Alessandro R. Fever in acute stroke worsens prognosis. A prospective
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144 J Chin Med 20(3,4): 137-144, 2009 HEAD INJURY WITH FEVER TREATED WITH COMBINATION OF TRADITIONAL CHINESE MEDICINE AND WESTERN MEDICINE A CASE REPORT Tsung-Chieh Lee 1, Wen-Jiuan Chen 1, Chun-Cheng Hou 1, Chih-Chuan Yang 2, Lun-Chien Lo 1 1 Department of Chinese Medicine, ChangHua Christian Hospital, ChangHua, Taiwan 2 Division of Neurosurgery, ChangHua Christian Hospital, ChangHua, Taiwan ( Received 15 th January 2009, accepted 28 th April 2009 ) This case is an eighteen year old male student, who had suffered from car accident on May 5, 2007. Due to the comatose consciousness, he was received CPR and sent to nearby hospital. The brain CT showed intracranial hemorrhage with intraventricular hemorrhage. Then he was transferred to our hospital for advanced treatment. The brain hemorrhage progressed and he received craniotomy with removal of hematoma on May 24, 2007. He was sent to ICU and high fever was noted. Even the antibiotics were used, but the temperature was still over 39 ºC. He was consulted with traditional Chinese medicine treatment on June 21, 2007. The patient presented comatose, skin rash under jaw, dry mouth, and high temperature with sweating. The sputum showed yellowish and sticky and physical examination revealed bilateral arm flexation, and lower leg extention. The stool constipation was treated by ducolax. Under the impression of blood stasis due to qi stagnation and internal harassment of phlegm-heat, the modified formular of huang qin qing dan tang was given to nourish yin, clear heat, regulate qi, resolve stasis, resolve phlegm, and downbearing the turbid. After combining care with Chinese medicine, the fever was controlled, and patient s consciousness improved. The case indicated that the cooperation of Chinese medicine and Western medicine would be a promising treatment modality for central fever after brain damage. Key words: head injury, fever, combination of traditional medicine and western medicine Correspondence to: Lun-Chien Lo, Department of Chinese Medicine, ChangHua Christian Hospital, No.135, Nanxiao St., Changhua City, Changhua County 500, Taiwan, Tel: +886-4-7238595 ext. 4228, E-mail: 126478@cch.org.tw